Coronavirus Act 2020: Temporary Provisions

Lord Patel Excerpts

Monday 28th September 2020 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, from the outset of the pandemic there has been a lack of transparency, openness and scrutiny of the policies in relation to pandemic management. This has been a pity. At the start of the pandemic, the Government stated that their policy in relation to managing the pandemic was to “follow” the science and be guided by it. Yet the membership of SAGE and the advice it got from it was confidential, and therefore the veracity of science advice underpinning the government decisions could not be challenged.

The purpose of the emergency powers was to enable the Government to plan an effective response to the pandemic. The effectiveness of the various pieces of legislation and guidance in doing so can be measured in many ways. The simplest way would be to look at some key outcomes. The noble and learned Lord, Lord Judge, mentioned the need to balance health and wealth. In terms of health, the UK ranks number five in the world for deaths directly related to Covid-19, at 41,936 deaths. Compare that to Germany, which is ranked at number 19, which has had 9,519 deaths. Comparing deaths per million population, the UK has had 618 deaths per million citizens, compared with Germany’s 119 deaths per million population. Similarly, we have higher infection rates. Are the differences related to quality of decision-making? Policy related to testing for infection was key to better management. Germany got it right, resulting in better outcomes for health and wealth. Several of our distinguished scientists pleaded for a similar strategy at the beginning of the pandemic; I believe one of our Nobel laureates wrote to the Prime Minister suggesting that.

Since April, the Science and Technology Committee of the House of Lords, which I chair, has been taking evidence on the science behind the control of the pandemic to help guide policy decisions, particularly its ongoing management. At the end of July, having taken evidence from some of our most distinguished scientists and epidemiologists, I, as chair of the committee, wrote to the Prime Minister, outlining the key areas of pandemic management that needed urgent attention to avoid a second wave, and pointing out that we had two months in which to do this. The areas of concern highlighted in the letter were: to reduce levels of infection by October; to make sure that testing capacity can meet the needs; a clear plan of national and local public health leadership to help control any emerging infections; and, above all, the need for transparency, openness and scrutiny of decisions taken to inform clear public messaging. I understand that my counterpart in the House of Commons had also written to the Prime Minister following their evidence sessions.

October is nearly here, and we face increasing levels of infection. That leads to my concerns about our opportunity to scrutinise the evidence used by government and its likely impact on management of the pandemic. The House has significant expertise in all areas of science, economy, law and social behaviour to help make better decisions. I hope the Government accept that some of the policy decisions might have benefited from wider input to protect the health and economic welfare of our citizens. I most sincerely hope that government finds ways to enable Parliament to have more involvement in decision-making before decisions are made. The usual 30-second question to the Minister at the end of a Statement is hardly holding government to account or helping to make better decisions.

My question to the Minister is simple: how do the Government plan to get Parliament more involved?

Covid-19 Update

Lord Patel Excerpts

Monday 21st September 2020 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, I want to pick up on what the noble Baroness, Lady Thornton, said about the clarity of messages. Enough has been said about test, track and isolate, and I will not go there, but I want to pick up on the comment made by the Chief Medical Officer in the presentation this morning about how people’s changing behaviour may help reduce or suppress the transmission of the virus significantly. The Government’s slogan “Hands, Face, Space” is apt. The Government were quite clear at the beginning of the pandemic about handwashing but less clear about face masks or face coverings and space. In future, as we are facing a serious problem, what message does the Minister wish to give to citizens when it comes to the use of face masks and space?

[Lord Bethell (Con)]

Our message remains clear and the same as when we started this epidemic. There is no other better alternative than the three principles articulated by the noble Lord, Lord Patel: clean hands, clean face, and social distancing. That mixture of hygiene and social distancing is the only thing that can beat this virus; that is our first line of defence. Test, trace, and isolate is our second line of defence. Face masks—in situations where social distancing is a challenge—can provide some secondary back-up, but they are not our primary form of defence.

Covid-19 Update

Lord Patel Excerpts

Monday 14th September 2020 Lords Chamber

[Lord Bethell (Con)]

I thank my noble friend for his comments, but my perspective is slightly different. The fact is that this disease is incredibly aggressive and nimble; we sometimes have to turn decisions around literally within hours. I cannot think of another situation, other than war, where the decision-making has to be quite so quick. I would love to be able to bring regulations to this House for full debate in advance of their implementation, but no human institution can move at that kind of speed—it is just not possible. In answer to his question, we have no plans to switch horses at the moment. We are working as hard as we can to bring regulations here as quickly as we can, and I pay tribute to the House authorities for doing everything they can to put regulations in front of the House as quickly as they can.

[Lord Patel (CB) [V]]

My Lords, the Office for National Statistics records over 52,000 deaths of people whose death certificates have Covid-19 as a contributory cause. More than 42,000 of these deaths were of people over the age of 65. As the numbers of infections increase, which they are, more older and vulnerable people will be infected—as has happened in France—leading to a rise in hospital admissions and deaths. What plans do the Government have as the rate of infection increases in our country to protect the elderly and more vulnerable?

[Lord Bethell (Con)]

My Lords, we are discussing, among other things, the very regulations we are putting in place to protect the elderly and vulnerable. The rule of six, although not part of this provision, is an emphatic commitment to protect the people whom the noble Lord cites. I add that we are concerned about not only the elderly and vulnerable; we are increasingly concerned about the phenomenon of long Covid, which hits the young. It is one of our objectives to rid this country of Covid altogether and to protect all demographics.

Covid-19 Update

Lord Patel Excerpts

Thursday 10th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is not a mutant algorithm that is sending people to hospital in France, Spain, Belgium and other countries up and down Europe, and it is not a desire to introduce a police state that is seeing prevalence leading to hospitalisation and death in many countries in Europe. It is our fear that Britain is going that way that leads us, regretfully, to put these measures in place; it is not any desire to exert state influence.

[Lord Patel (CB) [V]]

My Lords, I am sorry that the Minister keeps having a hard time, but that is partly because he is having to defend the indefensible. I had a completely different question to ask, but I have changed my mind and, instead, will follow on from the question asked by the noble Lord, Lord Lansley, and the Minister’s response to it. In terms of transmission of the disease indoors as opposed to outdoors, which bit of science is confusing?

[Lord Bethell (Con)]

I answered the question as clearly as I possibly could. This is about communication and clarity and making sure that people understand the instructions; it is not about science. If that is not effective then the guidelines are pointless.

Folic Acid

Lord Patel Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely accept the urging of my noble friend Lord Balfe on this matter. He is entirely right. There is very strong scientific evidence in this area; the Government accept that, and this is why they have launched a consultation, which was due to be published earlier this year. However, Covid has blown us away and that is why the announcement has been delayed. The Government have listened to the scientific evidence, which is very persuasive, and the decision will be made when the time is right.

[Lord Patel (CB) [V]]

My Lords, this is the fourth occasion that I have supported this Question put down by the noble Lord, Lord Rooker. Every time, there has been a disappointing Answer. As an obstetrician, I have seen many, many pregnancies result in serious spina bifida and anencephaly. Previously, the Government have used the excuse that overdosing might result if we put folic acid in flour. Would the Minister confirm that the recent research does not support that view?

[Lord Bethell (Con)]

My Lords, the consultation on the proposal to fortify flour ran for 12 weeks from 13 June to 9 September 2019 and was undertaken on a UK-wide basis. The pilot ran extremely successfully; the use of the supplements by the flour manufacturers was affordable and their implementation of the pilot was achieved without much disruption, and it was an encouraging experience that gives us good evidence for taking this matter forwards.

Medicines and Medical Devices Bill

Lord Patel Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Lord Patel (CB) [V]]

My time limit curtails me from commenting on the Minister’s or other speeches, so I shall get on.

I know that the Government feel that this is a simple Bill that is needed to implement EU laws in UK legislation in relation to medicines and medical devices, but the implications of it go far beyond that. The Cumberlege report has added the need to strengthen the Bill in relation to patient safety.

In Part 1, the Government set out their ambition to have a world-class regulatory authority for medicines and medical devices that puts patient safety at the forefront and promotes innovation by making the UK “attractive” to investors. I cannot complain about that.

The Government have stated their ambition to make the UK a science superpower in which life sciences and the development of new medicines will play a crucial part. This Bill offers the Government an opportunity to say how they plan to do this but fails to do so. As the Science and Technology Committee report on life sciences indicated, the UK leads in life sciences research, but it is not very successful at taking research to innovation and commercialisation. The stated aim in the Bill to make the UK attractive is presumably to address this deficit, but it gives no definition of “attractiveness”, although the Minister referred to it in his speech. I hope that he will clarify it in more detail in Committee and even define “attractiveness”.

The Bill falls short of identifying how it will achieve its objectives, except that the Secretary of State will take wide powers to do it. Let me highlight the areas of my concern which I wish to explore in Committee. The Bill gives broad delegated powers to the Secretary of State to amend or supplement regulations. As the Delegated Powers Committee and the Constitution Committee—already referred to several times—recognise, some delegated powers may be necessary, but the Bill grants powers far wider.

Furthermore, the Bill adds to the complex regulatory regime rather than simplifies it. Clarification is needed as to how it intends to prioritise patient safety, even when there might be conflicting interests, such as “attractiveness” for investors. The findings of the Cumberlege review, that patients’ concerns were ignored, need to be addressed in the Bill. While the creation of a registry of devices is welcome, their safety and efficacy need to be addressed. I hope that my noble friend Lord Kakkar takes up this cause. If he does, I shall certainly support him.

Why will the MHRA be the regulator that licenses devices and maintains the register, but any new information systems are to be held by NHS Digital, referred to in the Bill as the information centre? What pre-market processing will there be for devices prior to approval for usage?

Clarification is needed from the Minister on the powers that the Secretary of State will have in emergency situations and on the removal of the duty of confidentiality and privacy afforded to patients. I want to explore how the Government plan to make the United Kingdom a prime destination to conduct clinical trials, an area of considerable concern for a wide sector of pharma. The Minister may well remember the debate at the time of the withdrawal Bill on clinical trials and making the UK a prime destination to conduct trials. The key point in being able to do this was the ability for the MHRA to have a close relationship with the EMA. What discussions are going on currently to enable this to happen? Regulations for medicines is a devolved issue for Northern Ireland, a potential area of divergence in the future from the rest of the UK. The implications of this need to be clarified in the Bill.

In conclusion, I am able to support much of the Government’s ambitions through this Bill to make UK regulations in medicine world-leading. Having said that, I will support amendments that allow for greater scrutiny of the powers of the Secretary of State, place greater emphasis on patient safety and give a clear commitment to allow the MHRA to make strong partnerships with other regulators. I look forward to Committee.

Covid-19: Response

Lord Patel Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is entirely right that these local outbreaks create invidious choices for local authorities, and the fine tuning of the boundaries is an important part of the lockdown process. We saw that in Leicester, where the boundaries of the lockdown were changed for the very reasons that she outlines, both to preserve trust and in order to be effective. However, I remind the noble Baroness that the movements of people within areas mean that the disease can spread. Therefore, the lockdowns do not necessarily apply only to those areas with high prevalence in any one period, and sometimes buffers need to be put around the infection area, which is why these areas can seem to be either unfair or overextended.

[Lord Patel (CB) [V]]

My Lords, Amnesty has reported that the UK has had 540 deaths among health and care workers, second only to Russia. Compare that to Spain, which has had 63 deaths. Have the Government carried out a root-cause analysis to find out the causes of these deaths, and will they publish the results? If the Government have not carried out such an analysis, will the Minister agree that one should be carried out with some urgency in case there is a second wave of infection?

[Lord Bethell [V]]

My Lords, local trusts have been urged for many months now to undertake a profound risk assessment of workers, particularly BAME workers, in order to understand where infection may have come from. Infection control teams in individual trusts are charged with the responsibility for delivering infection control plans. It is at that level that we can understand the detailed causes of infection because in each trust those causes can be quite different.

Independent Medicines and Medical Devices Safety Review

Lord Patel Excerpts

Thursday 9th July 2020 Lords Chamber

[Lord Bethell]

I thank my noble friend for his comments and for his role in commissioning this important report. His point on the safety commissioner is extremely well made. I am not ruling out anything whatever, but we need time to study the report before we can make any commitments.

[Lord Patel (CB) [V]]

My Lords, I thank the noble Baroness, Lady Cumberlege, and her team for what is a hard-hitting report, and rightly so. Reading it, I felt anger and shame—anger that so many women patients were treated with such disdain and felt that they were not listened to; and ashamed that members of a profession I belong to showed such ignorance, arrogance, duplicity and callousness towards the very people who put trust in them. As a member of that profession, I apologise wholeheartedly to women who suffered and I hope that the profession takes heed of them. Much of the report draws on narratives from women, and I was struck by one who called herself

“an unsuspecting, unwilling participant in a cruel experiment”.

No patient should ever feel that. I hope this report is a wake-up call for the professional organisations too, to take charge and become more patient-focused, rather than professional-focused, and to deliver the care that patients deserve. I am a long-time supporter of the charity Epilepsy Action. It has welcomed the report and hopes that action will be taken soon, particularly for women and mothers in relation to sodium valproate. I support the questions asked of Ministers and I hope we will soon see action.

Covid-19 Update

Lord Patel Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

I reassure my noble friend that anyone who has reason to believe that they may have been infected by the virus is eligible for the test. The resources we have put into testing are now enormous. There are nearly 300,000 tests a day. Those in Buckinghamshire who are too far away from the drive-in testing facility should apply for an at-home testing kit.

[Lord Patel (CB) [V]]

My Lords, I agree with much of what the noble Baronesses, Lady Thornton and Lady Brinton, had to say. In response to them, the Minister said the dashboard will provide data about the infection rate to local authorities and local healthcare. If that is so, I welcome it. Does that mean a change in policy towards greater involvement of local public health directors in managing this pandemic?

[Lord Bethell]

To be clear to the noble Lord, the dashboard was made available on 22 June. It has a very large amount of local information, including information from 111, hospitals and the test and trace programme. The analysis of the data will be enhanced using the latest technology in order to give the most granular information possible. Those enhancements will be rolled out very shortly.

Covid-19: Test and Trace App

Lord Patel Excerpts

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, I completely endorse the noble Lord’s point. We have followed the principle of working in parallel in all cases possible. However, I should explain that pressure is incredibly intense, and one cannot focus on everything all the time. I understand the point that he makes, but I suggest that, at some points, one has to focus on one part at a time. That is what we have sometimes needed to do, but we have remained in contact with all players at all times.

[Lord Patel (CB) [V]]

My Lords, I have one question in two parts. First, in the event of a substantial increase in the number of new infections, what plans do the Government have to manage such an increase, and will they publish them? Secondly, what plans do they have to use antibody screening of the population?

[Lord Bethell]

My Lords, our plans for the winter are in development and I look forward to their publication. The noble Lord is entirely right to prioritise antibody screening. We have invested considerably in antibody testing from a number of suppliers, including Roche and Abbott. As he knows very well, the science remains ambiguous, but we are optimistic. That is why we are putting our best minds to understand it better, and we are world-leading in that respect.